Basic Information
| Provider Information | |||||||||
| NPI: | 1366425902 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PETERSON | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1108 TAMWORTH HILL LN | ||||||||
| Address2: | |||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275198860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196510189 | ||||||||
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| Practice Location | |||||||||
| Address1: | 97 CORNERSTONE DR | ||||||||
| Address2: | |||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275198403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194600993 | ||||||||
| FaxNumber: | 9194813952 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2005 | ||||||||
| LastUpdateDate: | 09/07/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 2006-00675 | NC | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.